Radial SD-OCT of the bilateral maculae revealed focal disruption of the ellipsoid zone and interdigitation zone at the fovea. Click image to enlarge.

The Optometric Retina Society (ORS) has announced this year’s winner of its annual Larry Alexander Resident Case Report Contest. Vasudha Rao, OD, an ocular disease, low vision and geriatric optometry resident at the Palo Alto VA, presented a case involving a 41-year-old white male with poppers maculopathy, a condition characterized by bilateral subfoveal ellipsoid zone disruption, yellow foveal spot and reduced visual acuity. Dr. Rao’s report discusses differential diagnoses based on macular OCT, the various manifestations of the condition and options for management.

This case was selected by the ORS Awards Committee as the winner of the seventh annual contest, named in honor of Larry Alexander, OD, who passed away in April 2016. Dr. Alexander had a distinguished career as an educator at the University of Alabama Birmingham School of Optometry, a prominent lecturer and, perhaps most notably, author of the seminal work Primary Care of the Posterior Segment. He was also a past president of the ORS. The group chose to honor his legacy by accepting case reports from optometric residents across the country relating to vitreoretinal disease.

“It is truly an honor to chair the Larry Alexander Case Report Contest, as it provides me with the unique opportunity to read case reports from residents nationwide,” says Julie Rodman, OD, professor and chief of the Fort Lauderdale (Broward) Eye Care Institute at Nova Southeastern University in Florida. “These residents are knowledgeable and amazing writers. There is no doubt that they are being provided with amazing clinical experiences. This year’s winner provided an outstanding report on poppers maculopathy.”

The full text and images of Dr. Rao’s paper will be available at reviewofoptometry.com on July 15, the day the July 2024 issue goes live.

Dr. Rao’s case report notes that poppers maculopathy is a rare, bilateral condition most common in men that is associated with the use of nitrite alkyl inhalants, an angina drug often used recreationally to bring about feelings of euphoria. Poppers contain alkyl nutrites that induce an upregulation of nitric oxide synthase, which produces excessive nitric oxide. High amounts of nitric oxide can increase light response of cones, causing chronic activation and apoptosis of foveal cones. This theory, Dr. Rao’s report states, explains why excessive cone activation in poppers maculopathy can resemble photic maculopathy.

The paper on Dr. Rao’s case also emphasizes the importance of how this condition is reversible, as foveal EZ-RPE disruption on OCT and visual acuity loss often improve over time, and cessation of the illicit drug may improve visual and functional outcomes for patients.